scholarly journals E-mental health interventions for young adults with early psychosis and cannabis use disorder: a qualitative study of patient and clinician perspectives (Preprint)

2020 ◽  
Author(s):  
Ovidiu Tatar ◽  
Amal Abdel-Baki ◽  
Christophe Tra ◽  
Violaine Mongeau-Perusse ◽  
Nelson Arruda ◽  
...  
Keyword(s):  
Young Adults ◽  
Psychological Intervention ◽  
First Episode Psychosis ◽  
Cannabis Use ◽  
Early Psychosis ◽  
First Episode ◽  
Psychological Interventions ◽  
Cannabis Use Disorder ◽  
Episode Psychosis ◽  
Clinician Perspectives

BACKGROUND Persistence of cannabis use disorder (CUD) in young adults with first episode psychosis is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EIS) for psychosis is inconsistent due to barriers including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability. OBJECTIVE The purpose of this study was two-fold: 1) to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis, and 2) to explore factors related to the development and implementation of a technology-assisted psychological intervention. METHODS Ten patients undergoing treatment for first episode psychosis (FEP) and CUD in EIS participated in a focus group in June 2019. Semi-structured individual interviews were conducted with ten clinicians working in first episode clinics in the province of Québec, Canada. A hybrid inductive-deductive approach was used to analyse data. For deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to online interventions for substance use (i.e., tailoring, reminders, delivery strategies, social support and incentives). For inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers. RESULTS Data was synthesized in five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences of patient and clinician perspectives was produced. The categories included: attitudes and beliefs related to psychological intervention (e.g., behavioral stage of change), strategies for psychological interventions (e.g., motivational interviewing), incentives (e.g., financial), general interest in TBPIs (e.g., facilitators and barriers), and tailoring of TBPIs (e.g., outcome measures of interest for clinicians). CONCLUSIONS This study provides a comprehensive portrait of the multi-faceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis. CLINICALTRIAL N/A

scholarly journals Technology-Based Psychological Interventions for Young Adults With Early Psychosis and Cannabis Use Disorder: Qualitative Study of Patient and Clinician Perspectives

10.2196/26562 ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. e26562
Author(s):  
Ovidiu Tatar ◽  
Amal Abdel-Baki ◽  
Christophe Tra ◽  
Violaine Mongeau-Pérusse ◽  
Nelson Arruda ◽  
...  
Keyword(s):  
Young Adults ◽  
Psychological Intervention ◽  
Cannabis Use ◽  
Early Psychosis ◽  
First Episode ◽  
General Interest ◽  
Psychological Interventions ◽  
Cannabis Use Disorder ◽  
Web Based ◽  
Clinician Perspectives

Background The persistence of cannabis use disorder (CUD) in young adults with first-episode psychosis (FEP) is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EISs) for psychosis is inconsistent because of barriers, including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability. Objective The aim of this study is twofold: to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis and to explore factors related to the development and implementation of a technology-assisted psychological intervention. Methods A total of 10 patients undergoing treatment for FEP and CUD in EISs participated in a focus group in June 2019. Semistructured individual interviews were conducted with 10 clinicians working in first-episode clinics in the province of Québec, Canada. A hybrid inductive-deductive approach was used to analyze data. For the deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to web-based interventions for substance use (ie, tailoring, reminders, delivery strategies, social support, and incentives). For the inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers. Results Data were synthesized into five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences between patient and clinician perspectives was produced. The categories included attitudes and beliefs related to psychological interventions (eg, behavioral stage of change), strategies for psychological interventions (eg, motivational interviewing, cognitive behavioral therapy, psychoeducation, stress management), incentives (eg, contingency management), general interest in TBPIs (eg, facilitators and barriers of TBPIs), and tailoring of TBPIs (eg, application needs and preferences, outcome measures of interest for clinicians). Conclusions This study provides a comprehensive portrait of the multifaceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis.

Developing a theoretical framework for persistent cannabis use among young adults with first episode psychosis

2021 ◽  
Author(s):  
Leslie Marino ◽  
Samantha E. Jankowski ◽  
Rick Kent ◽  
Michael L. Birnbaum ◽  
Ilana Nossel ◽  
...  
Keyword(s):  
Young Adults ◽  
Theoretical Framework ◽  
First Episode Psychosis ◽  
Cannabis Use ◽  
First Episode ◽  
Episode Psychosis

Retrospective study of first episode psychosis in the Dublin Southwest Mental Health Service: demographics, clinical profile and service evaluation of treatment

2017 ◽  
Vol 36 (4) ◽  
pp. 249-258 ◽  
Author(s):  
A.-M. Clarke ◽  
P. McLaughlin ◽  
J. Staunton ◽  
K. Kerins ◽  
B. Power ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Service ◽  
Family Intervention ◽  
First Episode Psychosis ◽  
First Episode ◽  
Psychological Interventions ◽  
Duration Of Untreated Psychosis ◽  
Episode Psychosis ◽  
Baseline Information ◽  
Healthcare Monitoring

ObjectiveIn Ireland, National Clinical Programmes are being established to improve and standardise patient care throughout the Health Service Executive. In line with internationally recognised guidelines on the treatment of first episode psychosis the Early Intervention in Psychosis (EIP) programme is being drafted with a view to implementation by mental health services across the country. We undertook a review of patients presenting with a first episode of psychosis to the Dublin Southwest Mental Health Service before the implementation of the EIP. This baseline information will be used to measure the efficacy of our EIP programme.MethodsPatients who presented with a first episode psychosis were retrospectively identified through case note reviews and consultation with treating teams. We gathered demographic and clinical information from patients as well as data on treatment provision over a 2-year period from the time of first presentation. Data included age at first presentation, duration of untreated psychosis, diagnosis, referral source, antipsychotic prescribing rates and dosing, rates of provision of psychological interventions and standards of physical healthcare monitoring. Outcome measures with regards to rates of admission over a 2-year period following initial presentation were also recorded.ResultsIn total, 66 cases were identified. The majority were male, single, unemployed and living with their family or spouse. The mean age at first presentation was 31 years with a mean duration of untreated psychosis of 17 months. Just under one-third were diagnosed with schizophrenia. Approximately half of the patients had no contact with a health service before presentation. The majority of patients presented through the emergency department. Two-thirds of all patients had a hospital admission within 2 years of presentation and almost one quarter of patients had an involuntary admission. The majority of patients were prescribed antipsychotic doses within recommended British National Formulary guidelines. Most patients received individual support through their keyworker and family intervention was provided in the majority of cases. Only a small number received formal Cognitive-Behavioural Therapy. Physical healthcare monitoring was insufficiently recorded in the majority of patients.ConclusionsThere is a shortage of information on the profile and treatment of patients presenting with a first episode of psychosis in Ireland. This baseline information is important in evaluating the efficacy of any new programme for this patient group. Many aspects of good practice were identified within the service in particular with regards to the appropriate prescribing of antipsychotic medication and the rates of family intervention. Deficiencies remain however in the monitoring of physical health and the provision of formal psychological interventions to patients. With the implementation of an EIP programme it is hoped that service provision would improve nationwide and to internationally recognised standards.

Childhood symptoms of inattention–hyperactivity predict cannabis use in first episode psychosis

2011 ◽  
Vol 132 (2-3) ◽  
pp. 171-176 ◽  
Author(s):  
Clifford M. Cassidy ◽  
Ridha Joober ◽  
Suzanne King ◽  
Ashok K. Malla
Keyword(s):  
First Episode Psychosis ◽  
Cannabis Use ◽  
First Episode ◽  
Episode Psychosis

Suicide Prevention in First Episode Psychosis: The Development of a Randomised Controlled Trial of Cognitive Therapy for Acutely Suicidal Patients With Early Psychosis

2003 ◽  
Vol 37 (4) ◽  
pp. 414-420 ◽  
Author(s):  
P.J.R. Power ◽  
R.J. Bell ◽  
R. Mills ◽  
T. Herrman-Doig ◽  
M. Davern ◽  
...  
Keyword(s):  
Early Intervention ◽  
Treatment Group ◽  
Young People ◽  
Controlled Trial ◽  
First Episode Psychosis ◽  
Early Psychosis ◽  
First Episode ◽  
Episode Psychosis ◽  
Randomised Controlled ◽  
Suicidal Patients

Background: Young people with early psychosis are at particularly high risk of suicide. However, there is evidence that early intervention can reduce this risk. Despite these advances, first episode psychosis patients attending these new services still remain at risk. To address this concern, a program called LifeSPAN was established within the Early Psychosis Prevention and Intervention Centre (EPPIC). The program developed and evaluated a number of suicide prevention strategies within EPPIC and included a cognitively oriented therapy (LifeSPAN therapy) for acutely suicidal patients with psychosis. We describe the development of these interventions in this paper. Method: Clinical audit and surveys provided an indication of the prevalence of suicidality among first episode psychosis patients attending EPPIC. Second, staff focus groups and surveys identified gaps in service provision for suicidal young people attending the service. Third, a suicide risk monitoring system was introduced to identify those at highest risk. Finally, patients so identified were referred to and offered LifeSPAN therapy whose effectiveness was evaluated in a randomised controlled trial. Results: Fifty-six suicidal patients with first episode psychosis were randomly assigned to standard clinical care or standard care plus LifeSPAN therapy. Forty-two patients completed the intervention. Clinical ratings and measures of suicidality and risk were assessed before, immediately after the intervention, and 6 months later. Benefits were noted in the treatment group on indirect measures of suicidality, e.g., hopelessness. The treatment group showed a greater average improvement (though not significant) on a measure of suicide ideation. Conclusions: Early intervention in psychosis for young people reduces the risk of suicide. Augmenting early intervention with a suicide preventative therapy may further reduce this risk.

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